By Dr. Bulent Ender
Long standing (chronic) infection with the Hepatitis C virus (HCV) remains one of the most common causes of infectious hepatitis and cirrhosis (end stage liver disease) in the U.S. There have been significant advances in the understanding and treatment of HCV infection in the past decade. HCV is transmitted primarily through exposure to contaminated blood and illicit drugs, although up a third of the patients who are diagnosed with this infection may not be able to identify an obvious risk factor. Nearly 80% of patients exposed to the virus can develop chronic disease which can progress to scarring of the liver, cirrhosis and even liver cancer over several decades. Joint infection with Hepatitis B virus, HIV virus or history of chronic alcohol abuse hastens progression of the liver.
Vast majority of patients with chronic HCV infection have no symptoms. Complaints of jaundice, fluid retention, itching and extreme fatigue tend to be associated with advanced disease. Most cases of chronic HCV infection are diagnosed as a result of blood work including abnormal liver function tests, positive HCV antibodies and detection of HCV – RNA levels. Experts recommend routine testing of the baby-boomer generation born between 1945-65 (due to historically high prevalence of IV drug abuse infection in this group). Aside from determining the presence of HCV virus, physicians also test patients to determine the variant of the virus (genotype) in circulation and assess the degree of liver damage caused by the presence of chronic infection.
Chronic HCV has now become a readily treatable disease with over 95% cure rates. The most common treatment modality for most patients consists of two antiviral medications combined into a single pill (Harvoni). The treatment regimen typically lasts 2-3 months and is well tolerated with minimal side effects. However due to the expense of treatment (in the range of $50,000) insurance companies are rationing the medication by restricting the coverage for patients with more advanced form of fibrosis (scarring liver disease). There are alternative medication treatments available for patients depending on their genotype, disease status and prior exposure/experience to antiviral drugs. Bulent Ender, MD
Steps in the progression of HCV infection are outlined below. The goal is to interfere (treat) in the mid-point of this disease process, prior to complications.